Dr José Carlos Mori – specialist in Allergy and Clinical Immunology at the Brazilian Association of Allergy and Immunology (Asociación Brasileña de Alergia e Inmunología – ASBAI), former postgraduate lecturer in Allergy and Immunology at the Grupo Educativo Afya, and medical director and CEO of IPI Asac Brasil – shares his opinion on the prevalence of allergic diseases in Brazil and the benefits sublingual immunotherapy can bring to patients.
- Regarding allergen hypersensitivity, have you noticed an increase in cases in recent years?
In my 27 years’ activity as CEO of IPI Asac Brazil, we’ve noticed a growing increase in allergic diseases, which currently affect over 30% of the Brazilian population.
- What is the general situation of allergies in Brazil? How has allergic pathology evolved in recent years?
Due to climate change, pollution, dietary habits and gut microbiota, changes are occurring in the prevalence, severity and even the allergens causing IgE-mediated (or non-IgE-mediated) allergic symptoms.
We’re seeing a growing increase in respiratory and cutaneous allergies. Another important observation is the increase in food allergies and the prevalence of certain allergies that were previously not very common in Brazil.
- What are the main allergens in Brazil? How does climate affect allergies? Do you think pollution influences allergies even more than before?
House dust mites are the main cause of IgE-mediated allergies, and account for around 80% in Brazil. The most common species are Dermatophagoides pteronyssinus and Blomia tropicalis.
Pollen is only present in the south of Brazil (Paraná, Santa Catarina and Rio Grande do Sul). Animal dander and fungi account for a small portion of the allergies in Brazil – scientific literature estimates a prevalence of 5%. However, we’re observing an increase in sensitivity to dog and cat dander, and one cause may be the adoption of pets during the pandemic.
- Regarding sublingual immunotherapy, how do you think it will evolve in the next few years?
Improvements in the quality and concentration of extracts for sublingual immunotherapy has boosted its use by 60%.
What we see here in Brazil is the high cost of sublingual immunotherapy. Nonetheless, some doctors and patients prefer to start immunotherapy sublingually because of the lower risk of adverse reactions.
- From your clinical experience, what advantages could sublingual immunotherapy bring to your patients?
The sublingual pathway is more comfortable, easier for the patient to use at home and has fewer adverse reactions. In the city of São Paulo, because of the distances (between the home and the doctor’s office) and the journey time, the sublingual pathway is very appealing for patients.
- How does a high concentration of allergenic extracts relate to proper efficacy?
First, we know the importance of biologically standardised extracts, and with the quantification of molecular allergens, we can get a standardised extract and prepare a treatment based on the concentration of its molecular allergen fractions. In Brazil, as we know dust mites are the most significant, we can quantify these molecular allergens, and prepare a personalised and individualised treatment with a high concentration of the main allergens. This can provide us with the most suitable allergenic extract for each patient.
- How can we guarantee the extract is of high quality and will give the patient a good outcome?
Scientific studies show that in order to obtain a long-term outcome (around 8 years after ending the treatment), without allergy crises and need for medication, it’s important to have a high-quality extract, tailored individualised doses and treatment lasting 3 to 5 years (after the maintenance phase).
To guarantee the quality of an allergenic extract, the doctor should request the standardised extracts and the amount of molecular allergens. For example, with the extract from dust mites such as Dermatophagoides pteronyssinus, the doctor should request the quantity of Der p1 and Der p2; and nowadays, with current knowledge, they should know the quantity of Der p23, as they are the major molecular allergens.
- Regarding your patients, do you think they adhere well to the treatment regimen?
In Brazil, as in the United States, Argentina and other countries in South America, the vials are diluted by the doctor for individualised treatment and a new vial is prepared at each visit for the maintenance of the treatment. Thus, the patient is monitored and is called back to apply of the injectable dose (SCIT) or requesting a new vial of sublingual immunotherapy (SLIT), achieving greater adherence to treatment.
In addition, another important factor for adherence is contact through direct messages with patients and/or parents. Some doctors use APP (Application software) for contacting patients who use immunotherapy.
- Do you consider that long term, AIT is a cost-effective treatment?
Scientific studies and clinical practice show that with a full treatment for 3-5 years, using quality, standardised extracts, with an effective dose, it’s possible to reach a cost and optimal cost-benefit outcome for the patient, assessing the patient’s quality of life, loss of working days at work and/or school, costs of symptomatic medication, costs of medical consultations and hospital admissions, and emergency care.
